Metabolic Acidosis with Contraction Alkalosis

Venous blood gas showed that patients pH was within normal limits. However, b-hydroxybutyrate and anion gap were both elevated. This is associated with metabolic acidosis. Contraction alkalosis was considered the etiology due to concomitant low chloride levels in the setting of volume loss. Some studies have shown that pH less than 6.9 necessitates 88 mmol of sodium bicarbonate over 1-2 hr.